<%-- 
    Document   : k3-input
    Created on : 24 Mar 11, 13:09:52
    Author     : Bayu
--%>
<%@page contentType="text/html; charset=UTF-8" pageEncoding="UTF-8"%>
<%@ taglib prefix="c" uri="http://java.sun.com/jsp/jstl/core"%>
<%@ taglib prefix="fmt" uri="http://java.sun.com/jsp/jstl/fmt" %>


<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"
   "http://www.w3.org/TR/html4/loose.dtd">

<html>
    <head>
        <meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
        <title>K3 Input Data</title>
         <jsp:include page="includes/script.html"/>
    </head>
    <body>
       <center><h2>K3 Input Data </h2>
            <br>
        <form method="post">



            <table>
                <tr>
                    <td>Tanggal</td>
                    <td><input type="text" name="date" readonly>
                    <img src="images/calendar.gif" onclick="displayDatePicker('date', false, 'ymd', '-');" />
                    </td>
                </tr>
                <tr>
                    <td>Keterangan</td>
                    <td>

                        <select name="note">
                            <option value="T">Tanpa Kecelakaan</option>
                            <option value="R">Kecelakaan Ringan</option>
                            <option value="B">Kecelakaan Berat</option>
                        </select>
                    </td>
                </tr>
                <tr>
                    <td>Note : </td>
                    <td><textarea name="description"></textarea></td>
                </tr>

                <tr>
                    <td colspan="2" align="right"><input  type="submit" name="submit" value="Save" ></td>
                </tr>
            </table>
        </form>

</center>
    </body>
</html>
